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Proposition 61 would require Medi-Cal to get VA prices for about 3 million of its patients (it excludes other Medi-Cal patients, who are on managed care plans). Rachel Sachs, a law professor at Washington University in St. Louis who studies drug pricing, said it’s unlikely the state can produce the same leverage as the VA.

“There are a whole set of legal obstacles, before this initiative can actually reduce prices in the way that its sponsors want,” Sachs said.

While Medi-Cal can create a preferred drug list, the federal government ultimately decides which medicines the state must pay for.

“Medi-Cal has to cover the drugs,” Sachs said. “So, telling Medi-Cal it can only pay the VA prices doesn’t give the state the bargaining power to walk away from the table.”